The good news is that “in some areas, it’s becoming a social norm to be circumcised, particularly among adolescents,” said Kelly Curran, director of HIV and infectious diseases at the Hopkins affiliate Jhpiego. In sub-Saharan Africa, the region of the world most devastated by AIDS, Kenya and Tanzania are making the most progress in reducing HIV infections, she added. Jhpiego implements HIV/AIDS treatment and prevention programs funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development.
The fight to stop new HIV infections accelerated in 2007, when the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization began to scale up voluntary medical male circumcisions to reduce transmission of the virus. According to Curran, the groups that year also endorsed three surgical methods for performing the procedure following successful trials in South Africa, Uganda and Kenya. Since then, 1 million men around the world have been circumcised. Three-fourths of the procedures were funded by PEPFAR, Secretary of State Hillary Rodham Clinton said November 8 while stressing that the U.S. goal is to see a global AIDS-free generation. Clinton has noted that about 34 million people still live with the disease.
“Virtually every other strategy we have to prevent and treat HIV/AIDS depends on people doing things that are not easy,” Curran said. She cited behavioral changes such as remembering to use a condom, reducing the number of sexual partners and learning the HIV status of partners. (Jhpiego offers circumcision to men and adolescents as part of a package of services that includes teaching the correct use of condoms, testing and treating sexually transmitted diseases, promoting safe sexual practices and offering antiretroviral therapy for people who are HIV-positive.)
Circumcision is a safe and simple procedure done by well-trained and -equipped medical providers that takes 20–30 minutes, she said. There is compelling evidence that circumcision reduces the risk of sexual transmission of HIV by 60 percent, according to UNAIDS. Circumcision also has been shown to reduce urinary tract infections.
|Three men wear T-shirts reading "Tohara ya Mwanaume," |
or "Male Circumcision" in a Tanzanian language.
Male circumcision benefits women because it reduces the transmission of other sexually transmitted diseases such as herpes and the virus that causes cervical cancer, according to Curran.
Curran said taking HIV prevention services close to where people live has been a successful strategy. In Tanzania, for instance, Jhpiego works with a nonprofit group that uses mobile health centers so men don’t have to walk long distances to be circumcised. Jhpiego also uses radio programs and short text messages to communicate information about HIV/AIDS prevention methods to targeted groups.
In order to help other countries reach the success levels that Kenya and Tanzania are experiencing, UNAIDS and PEPFAR announced December 5 a five-year plan to expand male circumcision services for HIV prevention in 14 countries in sub-Saharan Africa. The plan was developed by the two groups along with the World Health Organization, the Bill & Melinda Gates Foundation and the World Bank, in consultation with the national ministries of health of those countries.
If 80 percent of men in the 14 countries are circumcised, 3.4 million new infections could be averted and $16.5 billion in HIV/AIDS treatment costs could be saved, Curran said. Reaching 80 percent would entail performing 20 million circumcisions on men ages 15–49 by 2015, according to UNAIDS.
The 14 targeted countries are Botswana, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe.
The joint plan to scale up voluntary medical male circumcision is on the UNAIDS website. More information about PEPFAR and Jhpiego is on their websites.